One can imagine hearing this from the designers of California’s enhanced new prescription drug database.
After $3 million spent on redevelopment, the new system may not run on countless thousands of physician’s computers which are still using older internet browsers.
The state’s prescription drug database is called the Controlled Substances Utilization Review and Evaluation System, or CURES for short. It helps track prescriptions for narcotics and other high-risk drugs, allowing physicians and pharmacists to avoid overprescribing as well as help prevent patients suffering from addiction taking advantage of multiple doctors.
The new database was designed to run on newer browsers because they offer much better security against hacking into highly-sensitive personal medical information. But it turns out that some electronic medical record systems aren’t compatible with the safer modern browsers.
The risk of non-compatibility was so high, the California Medical Association sent out a memo to warn its doctors that thousands of them could lose access to the CURES system.
Turns out the Association’s warning was true.
Hundreds of hospitals, thousands of doctors
The Los Angeles Times reports that Kaiser Permanente, which employs more than 12,000 doctors statewide and operates 35 hospitals, falls into the incompatible category.
Other affected networks include Dignity Health, which operates 39 hospitals and eight pharmacies, and Sutter Health, which has 24 hospitals and 5,000 affiliated doctors.
That’s nearly 100 hospitals and many thousands of doctors right there. And there are apparently others.
State officials say they will launch the new CURES database as planned, but will also continue to run the older version for doctors who can’t access the new one. The downside is that the high security risks remain for those still using the older version.
Prescription drug databases like CURES have been proven effective in other states in preventing doctor shopping – catching both legitimate and fake patients seeking narcotic prescriptions from multiple doctors. The systems also help identify physicians who overprescribe addictive medications.
But a Los Angeles Times investigation in 2012 found that less than 10 percent of doctors, pharmacists and other eligible providers actually signed up to use the database. The Times reports helped publicize California’s prescription drug overdose epidemic and “prompted new state efforts to combat the abuse of painkillers,” the newspaper reported recently.
A 2013 law requires health practitioners who prescribe or dispense narcotics to subscribe to the database by the end of this year. But the California Medical Association opposes efforts by some lawmakers to make use of the database mandatory. They say the system has so far not been functional enough to impose such a requirement on doctors, the Times report says.
After the most recent incompatibility mess, it sounds like the CMA is right.
California voters said “no” to CURES because of privacy concerns
Meanwhile, voters last year rejected mandatory use of the database because of concerns about privacy. Use of the database was part of a state-wide ballot on increasing limits on medical malpractice awards and drug testing of physicians. The main objection to the database was its vulnerability to hackers.
A new bill has been introduced requiring doctors to utilize the CURES system before they can prescribe certain drugs, but it’s been delayed until 2016.
Bob Pack, a California Internet executive who champions the CURES database, told the Times that “concerns about technology are overblown.” Pack contends that the medical association is blowing the browser incompatibility issue out of proportion to avoid using the system.
“I see it as a way for the CMA to continually blast the CURES program,” Pack said.
Pack’s interest in the CURES database is personal. His two children were killed by an impaired driver who had obtained multiple prescriptions for painkillers, the Times said, which could have been avoided if the database had been consulted by the doctors and pharmacists involved.
Here at Novus, we work day and night, all year round, to help patients with drug and alcohol problems get their lives back. And there’s always that idea to get it done “before it’s too late” – before something dreadful like a car accident or overdose happens.
If you or someone you care for needs help with a drug or alcohol problem, call Novus right away – before it’s too late. We’re always here to help.
Unique new initiative in Gloucester, Mass.
The city of Gloucester, Massachusetts has embarked on a unique initiative in its fight against the state’s soaring drug epidemic.
The Gloucester Police Department announced last May that drug users can come in without fear of arrest or a record, turn over their drugs and paraphernalia, and immediately enter a treatment program.
The program began on June 1, and although it started slowly, it began rapidly picking up, and by the middle of June, 17 people had already taken the cops up on their offer. People coming in were abusing opioids like heroin, morphine and prescription opioids like oxycodone, according to a report on WBUR, Boston’s NPR station.
While the number appears modest, Chief Lenny Campanello says it represents more than three times the amount of people who have died of drug overdoses this year in the seaside community of about 29,000.
More than 1,000 overdose deaths were recorded for the state last year. That plus the early success of this new initiative has other communities interested in the Gloucester program.
The state’s largest city is eyeing the initiative
Boston Mayor Marty Walsh told WBUR he’s considering offering a similar program for the state’s largest city. Walsh called Gloucester’s program “a great idea and a great pilot program.”
Campanello wants the idea to spread everywhere. “We need to get people into treatment,” he told WBUR. “If they fail, we need to get them into treatment again. Just keep trying. Arresting them or coercing them into treatment just doesn’t work.”
The program has prompted a Gloucester resident and Boston-area businessman, John Rosenthal, to help Chief Campanello launch a privately funded nonprofit to “bolster the effort.”
“This program is life-saving, from Day One,” Rosenthal told WBUR. “And long term, it has the potential to change national drug and treatment policy.”
Rosenthal said the Police Assisted Addiction and Recovery Initiative will “help coordinate treatment for those struggling with addiction, support studies looking at the long-term effectiveness of the initiative and help other cities and towns replicate the efforts.”
From the police station straight to a treatment center
Campanello said instead of escorting program participants to the local emergency room for evaluation, a clinician works with them right in the police station in choosing a suitable treatment plan and location. A volunteer, called an “angel” – usually someone who’s been through addiction – stays with the applicant through the initial three-hour process.
Costs to the police department have been “minimal,” Campanello said, so far less than $1,000. Costs are being paid from the city’s drug seizure money. And the state covers the costs of drug treatment for participants who are Massachusetts residents with no insurance covering treatment, or no insurance at all.
Most of the 17 participants have been placed in treatment programs in Massachusetts. But other service providers across the country have said they’ll help if needed. And Campanello says 22 agencies in 15 states have even agreed to pay for those without health insurance.
Here at Novus, we’re impressed with Gloucester’s forward-looking treatment initiative. Moving from the slavery of addiction to the freedom of recovery and a drug-free life takes sincere and effective help, not a punitive approach. Don’t hesitate to call us if you need help and advice for substance abuse.
In northern Kentucky’s Kenton County, a new program sends non-violent heroin offenders directly for treatment instead of to jail. It’s proving very successful on many levels, and it’s also an official acknowledgement that heroin addiction can and should be treated, not punished.
An experimental program begun this past May in Kentucky’s Kenton County is sending non-violent heroin offenders directly for treatment instead of to jail.
Called the HEART program for Heroin Expedited Addiction Recovery Treatment, the new approach to drug offenders is rapidly gaining support from local officials and the public.
Kenton County is the northernmost tip of Kentucky, where the city of Covington, KY is really just part of the so-called Tri-State Greater Cincinnati Metropolitan Area. Cincinnati includes counties in Ohio, Kentucky and Indiana – all high-density urban areas where drugs and crime are part of the everyday scene.
A few prisoners in the Kenton County jail were the first to be sent for treatment in May. By early July, 25 prisoners had been sent – inmates charged with drug offences but not for violent crime, sitting around in their cells awaiting court dates. Local news reported that 22 of them were still on the program, with only three failures so far – one was sent back to jail and two more had skipped and had warrants out for their arrest.
Similar to drug courts in other counties and states, the HEART program doesn’t come with a free “get out of jail card.” If you do the detox and rehab program and stay clean, charges are dropped and you’re free on probation. If you don’t complete it, charges are reinstated and you’re back in jail.
Kenton County’s commonwealth attorney, Rob Sanders, told Local Channel 12, “If you are selling drugs or you make someone else into a crime victim you do not qualify. If you’re locked up for possessing drugs or drug paraphernalia or that sort of thing, you are only in there for making a victim of yourself, these are the people that are going to qualify.”
Kenton County only invested $10,000 to get the HEART project going, and it was based on solid expectations that it would eventually pay for itself and even save the county some money.
Several aspects make the HEART program a winner
The idea may be even better than many expected – and not just financially. It also offers substantial personal benefits for the offenders and for society at large.
The big personal and societal benefits are obvious.
Most, if not all program enrollees will complete their rehab and get their lives back as drug-free, law-abiding and contributing members of society. Recovery from addiction is a hugely valuable benefit – an ‘everybody wins’ benefit – all across the boards.
The financial aspects are of paramount importance to the bean counters – the accountants and committeemen whose overriding concerns are always about costs. The great news is that the HEART program’s operating expenses are already in the black. It’s paying for itself and saving the county some money.
Keeping a prisoner in Kenton County Jail costs $45 a day. Multiply that out for 25 or more prisoners lounging around in jail waiting for trial – probably for two or three months – and you soon see that jail costs can be more than the costs of treatment.
When you add in the potential for removing a large percentage of repeat offenders from the county’s legal system, and then add in their potential contributions as productive members of the community, and it’s a no-brainer.
And freeing up those jail cells makes that money available to lock up other criminals instead.
Finally, it should be mentioned that the HEART program puts everyone on notice that Kenton County officially recognizes that heroin addiction can be treated and should be treated, not punished.
The more jurisdictions that introduce these kinds of programs, the better. Prisons are far from the ideal environment for anyone to get off heroin and recover their lives.
Here at Novus, we can help you get your life back. Our innovations in drug detox don’t just address the cravings, they also build your health up so you have the best chance of all for a swift and successful recovery.
Whether it’s for you or someone you love, don’t hesitate to call Novus. We’ll answer your questions and help you map out the best plan for recovery.
A Massachusetts probation officer told the Salem News recently that it’s “frightening” how many heroin-addicted teenagers are turning up in court these days.
Lawrence District Court probation officer Danielle Murray said, “In the morning when we’re booking arrests, it’s drug case after drug case. I’ve noticed a younger population addicted to heroin than I’ve ever noticed in the last 10 years. It’s frightening to me the number of kids age 18, 19, 20 we’re seeing come in with a five- or six-year addiction.”
Other probation officers told the Salem News that they see many of the same faces over and over again – especially the young ones.
But getting busted for possession or a minor non-violent crime and appearing in drug court may be the best thing that could happen to these young addicts.
As the Salem News put it, “Many addicts who fail to get treatment, or just don’t want it, end up in the treatment system another way: through the courtroom.”
The Massachusetts Department of Probation says that court appearances for possession of Class A substances (heroin, morphine, GHB, ketamine etc.) have risen 90 percent in the past three years.
How most drug courts work
The way the Drug Courts work in Massachusetts is similar to those in other states. Those qualifying for the state’s Drug Court are usually busted for simple possession, no violence or dealing.
The deal with most drug courts is this: All Drug Court offenders are placed on probation. Those who haven’t been using too long are tested for dependency. If they successfully make it through the court-mandated treatment program, they have their case dismissed. If they fail to complete the treatment, their conviction is registered, fines may be levied, and they lose their driver’s licenses for specified times.
If they are re-arrested and fail treatment programs two or three times, they’re put on a “watch list” and are monitored more closely.
And if they’re known to have previously overdosed, or are at high risk of overdosing, they are considered a threat to themselves and the community and are incarcerated.
Drug court probationers will be sent for a bed at a court-appointed detox center. If they’re not able to qualify for drug court, it would mean a tougher detox at a local jail or nearby prison.
Probation officer Murray told the Salem News that although arrest and jail is a “last resort” for offenders addicted to opiates, probation officers have additional “tools” to help addicts get the treatment they really need and aren’t getting on their own.
“One strength probation has that is not available to the community at large is we can almost mandate they seek treatment,” Haverhill District Court probation officer Jim Sagris said.
Massachusetts controversial Section 35
One of those tools in Massachusetts is known as “Section 35” – a civil commitment to treatment, whether a crime of any kind has been committed or not. The statute allows the courts to “involuntarily commit someone whose alcohol or drug use puts themselves or others at risk. Such a commitment can lead to an inpatient substance abuse treatment for a period of up to 90 days.”
Parents or other responsible family members can apply for a Section 35 commitment for an addicted family member. If a judge agrees the need is urgent, treatment can be court-ordered and the addict is committed.
According to Murray, the chances are good that the person will get a detox bed right away, because the drug courts receive funding for detox beds that allow probationers to jump to the head of the line. However, there can sometimes be a wait, in which case the probationer is sent to a local state hospital.
“They don’t want to go, but they can’t be on the street,” Murray said. “They’re taken off and on probation so many times, we can’t trust them to be out on their own.”
Section 35 sounds a little primitive and scary at best, and a potentially serious problem since it also allows someone who has not been arrested or charged with any crime be committed to a state facility.
If it’s not being abused, such a commitment probably offers the best or only chance for such person, suffering such a dire addiction, to begin recovery. And that’s what keeps Section 35 on the books – the idea that the courts may be the last and only chance some addicts have.
But by its very nature, Section 35 seems unconstitutional. We reported a year ago how the American Civil Liberties Union (ACLU) filed a lawsuit challenging the state’s Section 35, on the grounds that it is unconstitutional. You can read more about that lawsuit here: ACLU lawsuit seeks end to primitive prison detox policy used on women addicts in Massachusetts.
Some people owe their lives to this controversial statute, but others are not so sure it’s in everyone’s best interests. Commitment to a state correctional institute when no crime has been committed is seen by many to exceed acceptable levels of state powers.
Aside from Section 35, the likes of which does not exist in many, if not most other states, what’s happening in Massachusetts with opioid addiction is happening everywhere else across the country.
Heroin addiction continues to increase, while the average age of new addicts continues to decrease. And drug court is often the “court of last resort” for countless addicted individuals.
For some, courts are an unexpected, unplanned chance for treatment that leads to recovery of a drug-free, crime-free life.
Here at Novus, we are deeply involved in helping each of our patients on their road to full recovery. We help people begin to get their lives back right now, so they never have to experience a courtroom as their only doorway to treatment. If you need help with a drug or alcohol situation, call Novus now.
All the way from the White House down to communities from coast to coast, opioid abuse is being called a public health crisis and an out-of-control epidemic.
But in spite of all the media coverage, official pronouncements and public clamor to take action, overdose death rates continue to climb.
Everywhere you go, the biggest problem is a lack of available and affordable treatment. And it isn’t being handled nearly fast enough. Overloaded treatment facilities, for both detox and rehab, continue to turn addicts away because they’re filled to capacity.
If you’re wealthy enough, maybe you can get into one of those expensive private facilities and rub shoulders with Hollywood celebrities or a rock star or two.
If not, you’re most likely to hear the dreaded phrase: “Put your name on the waiting list.”
The heroin epidemic and treatment shortages are “big news”
Opioid addiction and overdose deaths, and the lack of money and facilities to deal with the problem, is big news in the media.
For example, a series of penetrating articles recently in the Salem News reveals a whole slew of problems that Massachusetts is going to have to solve to combat the heroin epidemic in that state.
One of the biggest hurdles in Massachusetts and every other state in the country is the crucial shortage of detox and rehab beds. This situation leads inevitably to more and more addicts having to wait for a bed in a detox facility – a very bad situation when one is ready – finally – to begin that life-saving journey.
“Faced with a hellish withdrawal of sweats, shakes, vomiting and anxiety from an addiction that often has lasted many years, the individual will make a call for help to an inpatient detoxification center and quite likely be turned away,” a Salem News article on treatment shortages said. “As his or her body begs for another shot, another pill, the individual will be told to get on a waiting list for a bed in a treatment center. The wait could be days, even weeks.”
Weeks of waiting for detox or rehab risks relapse
This situation is being repeated in cities and towns across the country.
Even if a person is lucky enough to get into a detox center, their chances of getting into a rehab facility are slim. Right when they should immediately enter long-term rehab, they can end up waiting for weeks for a bed in rehab.
This opens the door to a possible relapse after a detox. And a relapse after detox means circling back to the end of the line waiting for another detox.
“They end up back on the detox waiting list, often by way of a courtroom or an emergency room,” the Salem News article said. “Sometimes this cycle happens time and again. In the rehab field, it’s called the ‘spin-dry.’
“You get detoxed, and if you’re lucky there might be a step-down service,” said Marylou Sudders, co-chair of Massachusetts Gov. Charlie Baker’s Opioid Task Force, told the Salem News. “A lot of people are told to wait or can’t find a bed for longer-term recovery. There seems to be a consensus that we need a more continuous level of treatment to help people reach recovery.”
Lack of facilities increases overdoses
The shortage of treatment facilities is adding to the danger of fatal overdoses, for two major reasons:
- Not getting into detox when the decision was made to do so leads back to street where the risk of overdose continues.
- If one is lucky enough to get into detox, but then can’t get into rehab right after, the risk of overdose increases if there is a relapse.
The decision to get clean is often fleeting. If not acted on right now it soon can vanish. Addicts can find themselves back on the street, once again risking arrest and death, in a matter of hours or a few days.
In the case of a relapse after detox, the risk of a fatal overdose increases. This is because opioid abusers develop tolerance, meaning they need ever-larger doses to get the same effects.
But after detoxing, their tolerance drops – their sensitivity to opioids increases.
And when addicts go back to the same big dose they were using before detox, they often can’t withstand it. They suffer an overdose, and frequently die.
Novus medical detox protocols offer greater protection
The risk of relapse following opioid detox – when the person doesn’t enter rehab right away – applies most often to the cookie-cutter, one-size-fits-all detox programs commonly offered across the country.
Novus has developed medical detox protocols that help patients alleviate the physical craving for opioids much more comfortably than all older methods. But Novus also addresses and treats every patient’s health level, which often has been compromised by the unhealthy lifestyles that usually accompany drug abuse. Increased level of health means more energy and stamina for the detox and for the subsequent period of rehabilitation.
Until the country catches up with the need for detox and rehab facilities everywhere else, think of Novus first. It’s in your best interest to call us at the first sign of a reach for help. Because help is what we provide in abundance.
Categories: Drug Overdose
“It’s not just a spliff round the barbecue”
A survey of a cross-section of lawyers in the UK finds that at least 27 percent of them regularly uses recreational drugs – and dangerously strong and addictive drugs at that.
The survey, performed by Legal Cheek, a popular UK legal news journal, said that the favored drugs were not a bit of weed now and then.
“It’s not just a spliff round the barbecue,” said the survey. “Nearly 80 percent of users are keen on class-A gear… the survey shows they have a taste for the hard stuff.”
By ‘class-A gear’ the survey refers to the UK equivalent of Schedule 1 or 2 drugs in the U.S. – opioids, cocaine, crack, methamphetamines – all the most dangerous and addictive drugs.
“Of those currently taking drugs, almost all at least occasionally indulge in class-A. Indeed, 89 percent said they take cocaine or crack, albeit with only 9% doing the latter,” the survey said.
Another 77 percent of lawyers currently taking drugs said they were keen on Ecstasy/MDMA, while 30 percent expressed a ‘retro fondness’ for psychedelics such as LSD.
“But marijuana is the most popular drug for lawyers,” said the survey. “Of those currently taking drugs, 93 percent said they enjoyed a spliff. Slightly more than 40 percent go for ketamine, while nearly the same percentage opts for magic mushrooms.
“Strikingly, four lawyers said they were currently at least occasionally enjoying the delights of heroin,” the survey added.
The survey uncovered strong support among UK lawyers for the “complete decriminalization of all drugs.” This opinion of the legal profession “flies in the face of recent government moves to ban a range of so-called legal highs,” according to the survey. “Some 54 percent of lawyers said drugs should be made legal, indicating that many of those in the front line of the ‘war on drugs’ — either prosecuting or defending dealers and users — reckon the battle is lost.”
While more than one lawyer in four was currently taking drugs, the survey found that overall use is “much higher. Nearly 60 percent of lawyers said they had at some stage in their lives taken illegal drugs.”
Another finding suggests that personal wealth influences drug habits. “Perhaps because their remuneration packages are far weightier, those solicitors practicing corporate-commercial law are more likely to take drugs than their counterparts slaving away at general practices,” said the survey. Roughly 56 percent of solicitors currently taking drugs work at commercial law firms, while only 36 percent are at the lower-paying general practices.
Criminal lawyers were “leading the way” in drug abuse – more than 60 percent of those currently taking drugs. Only 22 percent were in common law practices.
These findings are expected to “trigger some dismay” within the UK government, following an announcement to put before parliament the “Psychoactive Substances Bill” that proposes to “prohibit and disrupt the production, distribution, sale and supply of new psychoactive substances in the UK.”
In other words, it’s designed to crack down on what is seen as an increasing public interest in what can be called “legal highs.” The law would ban a wide range of substances, including the sale of nitrous oxide — more commonly known as “hippy crack” or “laughing gas.”
Mike Penning, Minister of State for Policing, Crime, Criminal Justice and Victims, said: “The landmark bill will fundamentally change the way we tackle new psychoactive substances — and put an end to the game of cat and mouse in which new drugs appear on the market more quickly than government can identify and ban them.”
Legal Cheek says that the professional implications for lawyers busted for doing drugs “remain vague.” Regulators apparently approach such situations on a “case-by-case approach.”
“For example,” says Legal Cheek, “the UK’s Solicitors Regulation Authority maintains that even a minor drugs conviction is likely to be considered a breach of rule 1.06 which states ‘you must not behave in a way that is likely to diminish the trust the public places in you or the profession’.
A UK legal authority told Legal Cheek that lawyers caught using drugs may be required to appear before a Solicitors Disciplinary Tribunal, and that any penalty “would largely depend on the circumstances.”
Lawyers convicted in a court of law for a drugs offence, or those reported for abusing drugs to the UK’s Bar Standards Board could get anything from a tap on the shoulder to disciplinary action.
It’s obvious from this survey that a lot of lawyers in the UK are messing around with drugs, and a lot more serious drugs than we feel comfortable with, considering that we put so much trust in our lawyers to protect our interests. What kind of defense can a lawyer put up for us if he’s just taken psychoactive drugs in the court washroom before addressing the judge or jury?
We aren’t aware of any similar survey here in the U.S. We can probably safely assume that there is a similar level of recreational drug use. If you’ve heard of any such survey of American lawyers regarding recreational drug use or any special or other treatment for drug offences in courts, by law societies or by Bar associations, we’d love to hear from you. Maybe we could do a U.S.-based blog on the topic.
Meanwhile, if you or someone you care for needs some expert help for drug or alcohol problems, don’t hesitate to call Novus today. We’ll do our best to explain all your options and help steer you to the best solution.
PICTURE CREDITS: Legal Cheek Ltd.
Forget about brewing up some boring old home-made beer. In the near future it’s going to be possible to whip up a batch of morphine or codeine right in your own kitchen – and you’ll use your own homemade beer-brewing kit and some very special brewer’s yeast to do it!
Scientists at the University of California, Berkeley (UCB), have just shown that it can be done – synthesize opioids such as codeine and morphine from special sugar from sugar beets combined with brewer’s yeast.
Of course, the article in Nature Chemical Biology was careful to point out that they concocted their home-made morphine in a lab, under strictly controlled conditions using genetically engineered sugar beets and yeast (with a some other foreign DNA tossed in).
In spite of all the tricky science, they’re saying that before too long, the process could be simplified enough to be carried out under less rigorous conditions. And many other scientists who’ve seen the UCB study agree.
“It is going to be possible to ‘home-brew’ opiates in the near future,” said Christopher Voight of the Massachusetts Institute of Technology (MIT), who was not involved in the research.
The process described in the study was inefficient, to say the least. It took 300 liters (nearly 80 gallons) of genetically engineered yeast to produce a single 30 milligram dose of morphine.
“But with improvements that are well within reach, that dose could be obtained from a glass of yeast culture grown with sugar on a windowsill,” Voight said.
Opioids – the go-to drugs for over 6,000 years
Morphine and other opioids have been the standard drugs for serious pain relief for thousands of years – in fact, their use predates recorded history , roughly 4,000 BC.
But opiates and opioids have always been derived from plants, especially the opium poppy. Their molecular structure is so complex, that scientists have never been able to duplicate them in the laboratory – until now.
Now, the UCB team has accomplished that task by engineering yeast to perform a crucial step in the synthetic opioid-producing reaction. A special enzyme was isolated from sugar beets, then genetically altered to make it “more productive” and then combined with the yeast. Additional foreign DNA was added to the yeasty brew, and voila! The specially formulated yeast completed the step needed to produce opioids.
“The whole process can be made more efficient,” said John Dueber, the lead UCB researcher. “It’s now a matter of linking all the steps together and scaling up the process.”
Less addictive, more effective pain relievers, but…
Discussion is ongoing about the possibility that this new research could lead to cheaper, less addictive and more effective pain-killers.
But most observers are more concerned that an easy, morphine-making yeast could significantly increase the availability of illegal opioids. And we’re already in a pills-and-opioids epidemic right now.
Comments from drug policy analysts published with the UCB study agreed that it could make illegal drugs “easy to grow, conceal and distribute” with little more than a home-brew beer-making kit. One suggested solution called for new policies to regulate engineered-yeast strains and confining them to “licensed facilities.”
But as the news service Reuters pointed out, the cat may be out of the bag. The recipe for opiate-producing yeast has already been made public. And “anyone trained in basic molecular biology could theoretically build it,” Dueber said.
Well, it’s not like you or your teenagers will be whipping up some morphine in your kitchen or basement workshop any time soon – and hopefully, it will be never. A degree in “basic molecular biology” isn’t all that common.
Meanwhile, here at Novus, we’re still doing our part in combating the opioid epidemic by providing the most advanced and successful medical opioid detox anywhere. So if you or someone you care for needs help with substance use or abuse, don’t hesitate to call us right away. We’re always here, helping people get their lives back.
A judge in Kentucky with decades of experience dealing with drug crimes and addictions says the state’s commitment to Suboxone to treat opioid addiction simply isn’t working.
Kentucky Drug Court Judge David A. Tapp, who serves Lincoln, Pulaski and Rockcastle counties in the 28th Judicial District, says he’s seen enough problems with Suboxone opioid addiction treatment to know it’s causing problems, not solving them.
Judge Tapp, who was awarded the prestigious National Association of Drug Court Professionals ‘All Rise’ award a few years ago, knows a thing or two about opioid addiction, treatment and drug-related crime. And he says Suboxone, which is itself an opioid, is more often than not being diverted and sold by addicts to pay for pills and heroin.
In an column he wrote for the Lexington Herald-Leader, Judge Tapp said that the newspaper’s recent claims that Suboxone will reduce addiction and overdose deaths is, to put it mildly, dead wrong.
“A recent Herald-Leader editorial,” Judge Tapp wrote, “supported using Suboxone (buprenorphine and naloxone) to treat opiate addiction. The editorial claims that with more taxpayer-funded Suboxone, opiate abuse and overdoses will decrease.
“Unfortunately, recent history demonstrates otherwise.”
The judge pointed out that Suboxone prescriptions are “rising dramatically within Kentucky — from approximately 5.6 million doses in 2011 to 11.6 million doses last year. Statistics from the Cabinet for Health and Family Services reveal that Medicaid alone paid approximately $27.6 million for buprenorphine products last year in Kentucky. It was the No. 2 drug in Medicaid costs last year.
“If more Suboxone equated with fewer overdose deaths and decreasing opiate dependence, we might have more to show for the nearly 34 million doses of Suboxone peddled within Kentucky since 2011,” Judge Tapp said. “Instead, opiate abuse abounds and our citizens continue to die.”
And even though Suboxone is widely available, Judge Tapp said, “it hasn’t slowed the rising prevalence of opiate addicted babies. Hospitalizations for addicted newborns continue an alarming climb — from approximately 29 in 2000 to well over 700 in 2011. Nearly 824 addicted infant hospitalizations were identified in 2012.”
The Herald-Leader editorial said that if used as prescribed, “the substitute drugs enable users to function normally, hold a job, go to school, without the impairment and craving that drive abusers to crime and other risky acts.”
Judge Tapp’s experience with drug courts presents an entirely different viewpoint.
“Unfortunately, Suboxone is frequently abused,” he said. “The real world is flooded with medication diverted from legitimate sources, long-term offenders who often test positive for Suboxone smuggled into jails, and hapless defendants who repeatedly report long-term opioid maintenance with no real path toward sobriety.”
The judge referred to the Food and Drug Administration’s warnings that “buprenorphine, like morphine and other opioids, has the potential for being abused and is subject to criminal diversion.”
The FDA cautions that Suboxone “may impair the mental or physical abilities required for the performance of potentially dangerous tasks such as driving a car or operating machinery.”
“Why?” asked the judge rhetorically. “Because Suboxone is a narcotic!”
Diversion of Suboxone is widespread in Kentucky. One of the state’s drug court actions is to perform drug tests on criminal defendants. From July last year through this past April, Kentucky administered 191,201 drug tests.
“Of those, 2,695 were positive for the illegal use of Suboxone and methadone — the very same dangerously addictive drugs which the Herald-Leader suggests are currently insufficiently available,” Judge Tapp pointed out.
“Our families, neighbors and communities need a real alternative to addiction — whether that addiction is to street drugs or to the medication prescribed to treat such addiction. No one should be satisfied with maintaining addiction, no matter the drug,” Judge Tapp said.
At Novus, we concur.
When the prescription opioid painkiller Numorphan in pill form was taken off the market 36 years ago in 1979, most people working in addiction treatment breathed a sigh of relief.
Throughout the 1960s and ‘70s, Numorphan (generic name oxymorphone) was seen to be responsible for countless thousands of addictions and overdose injuries and deaths. One of the most commonly abused prescription opioids at the time, the pills were usually dissolved and injected by addicts, many of whom preferred it to heroin.
By 1979, swayed by the wave of oxymorphone addictions and deaths across the country attributable to Numorphan, the FDA and the drug’s maker, Endo Pharmaceuticals, removed Numorphan tablets from the market. The injection and suppository forms of Numorphan were allowed to stay on the market and are still in use today.
So after a deadly 20-year run – it had been approved in 1959 – the pill form of Numorphan disappeared from pharmacy shelves in drug stores and hospitals across the country. Neither the FDA nor the drug maker admitted any connection to the 20-years-long Numorphan epidemic for its removal.
But then, in 2006, for some utterly inexplicable reason (well, on the surface at least) the FDA approved Endo Pharmaceutical’s application to approve the same drug all over again, but under a new trade name – Opana.
The FDA approved both Opana immediate-release and Opana ER for extended release. And then in 2011 the agency approved an “abuse-deterrent” version which, as with similar pills like abuse deterrent OxyContin, abusers are easily defeating the anti-injection properties of and are shooting up Opana like there’s no tomorrow.
The effects of Opana abuse are closer to those of morphine than of other widely abused opioids like OxyContin (extended release oxycodone). According to NYPress.com, OxyContin has “a more stimulating effect” than Opana, which can cause users to fall asleep. Like morphine, Opana’s greatest danger to abusers is the possibility of respiratory depression, the major cause of overdose death.
In addition to the ever-present risk of overdose, sharing needles among a large group of Opana abusers has been found responsible for a massive outbreak of HIV and hepatitis C infections in rural Austin, Indiana, and several Appalachian states.
The new Opana, according to a report in MedPage Today, is also associated with a blood-clotting disorder and permanent organ damage, problems that didn’t occur with injection abuse of earlier version of the drug, Numorphan, or injection of generic oxymorphone.
In addition to the tragedies associated with addiction and spread of disease, there’s another disturbing aspect of this whole Opana thing. When the FDA approved Opana, there already were dozens of other narcotic painkillers on the market. And plenty of them were already complicit in tons of cases of crime, abuse, overdose and deaths.
Why in the world would there need to be yet another opioid painkiller on the market, and one with a proven track record of destruction?
“There certainly didn’t seem to be a need for it,” said James Roberts, MD, a professor of emergency medicine at Drexel University College of Medicine in Philadelphia. As quoted in MedPage Today, Roberts added that “there are plenty of narcotics around for pain relief.”
As we’ve reported in earlier blogs and articles, the Milwaukee Journal Sentinel and MedPage Today collaborated on an investigation of oxymorphone’s “re-appearance” on the market. The investigative reporters observed a pattern of drug approvals over a decade or more, including “cozy relationships between regulators and drug company executives and the use of questionable clinical testing methods allowed by the FDA.”
Throughout the 2000s, records show, there were regular meetings of drug company execs, federal regulators and various academics involved in drug development, under the auspices of an organization funded by pain drug companies. These meetings were the subject of a 2013 Journal Sentinel/MedPage Today investigation. And Opana’s Endo Pharmaceuticals was a frequent attendee.
“The nation’s leading pharmaceutical companies paid entry fees running into the tens of thousands of dollars to attend invitation only conferences with FDA and NIH officials,” the reporters wrote. “Entry to these meetings was secured by annual fees from $20,000 to as high as $35,000. The drug companies that paid those fees were guaranteed the right to send a representative to the annual meetings.” And many of the academics invited to these closed-door meetings were offered payments of about $3,000 to attend.
The ostensible purpose of the meetings has been to come up with ways to fast-track drug trials – cutting back on almost every aspect of testing, even removing test subjects who suffer from side effects from the statistical outcomes.
Another thing: When Endo tried to get Opana approved in 2003, reports MedPage Today, the FDA said the drug didn’t appear effective enough in clinical trials. And there were safety concerns after several pain patients overdosed on the drug and had to be revived with emergency doses of naloxone.
Endo promptly removed anyone from the study who didn’t respond well to the drug, and the FDA approved it.
These approaches “essentially stack the deck in favor of the drug,” says MedPage Today. “More importantly, experts say, drugs tested that way are not likely to reflect what will happen when a drug gets on the market and is prescribed for large numbers of people.”
“It’s in fact cheating,” said Patrick McGrath, PhD, a pediatric pain expert at the Dalhousie University in Halifax, Nova Scotia.
The whole affair reeks of something resembling “pay to play” – not how the FDA is authorized to protect the American public from harm. For its part, the FDA denies any pay-to-play funny business.
But there’s no explanation to justify the approval of yet another dangerously addictive opioid painkiller into a world already awash in painkillers, a world already crushed by a prescription painkiller addiction epidemic.
Meanwhile, doctors are writing close to 800,000 Opana prescriptions a year. And Endo Pharmaceuticals is grossing an average $450 million a year.
And thousands of opioid addicts are finding plenty of Opana to go around, too.
If you or someone you care about is in trouble with drugs or alcohol, call Novus and get the help you need.
The small and almost unknown town of Austin, Indiana – population 4,200 – is the center of the worst surge in cases of HIV and Hepatitis C in state history. And the epidemic is stemming entirely from one drug – Opana ER extended release oxymorphone – being injected with shared needles.
Although Opana ER is made in an “abuse deterrent” form, users easily have discovered how to get around that mechanism, said Dr. Jerome Adams, Indiana’s State Health Commissioner. “It’s important that we all understand that just because a drug comes in an abuse deterrent form, that doesn’t automatically make it safe.”
By April of this year, the number of confirmed cases of HIV in southeastern Indiana had climbed to 136 just since November 2014. And this is in a region that historically has seen less than 5 cases a year. Meanwhile, there were six additional preliminary cases, said CDC officials, awaiting confirmation. If positive it would bring the total to 141.
Added to the HIV, co-infection with the Hepatitis C virus (HCV) also has been diagnosed in nearly 85 percent of patients.
The number of HIV cases rang alarm bells all the way from rural Indiana to the CDC. The state’s chief medical consultant told a CDC briefing that roughly four out of five infected patients reported injection drug use, while some of the others reported partners as injection drug users.
In Scott County, where most of the current infections are, fewer than five cases of HIV per year have been reported in the past. “This is the first outbreak of its type that we have seen documented in recent years,” said Dr. Jonathan Mermin, director of the National Center for HIV/AIDS in Atlanta.
Opana ER and shared syringes – a deadly combination
The majority of cases have been linked to dissolving tablets of the prescription opioid oxymorphone (Opana ER or Extended Release) and injecting it using shared syringes.
“We have not seen an outbreak of HIV specifically associated with the injection of oral opiates previously,” Mermin said. And the Indiana State Department of Health said that the injection drug use is “a group activity in this population” – with as many as three generations of a family, along with multiple community members, all injecting together and sharing needles.
Patients have ranged in age from 18 to 57 years and are on average 35 years old. A total of nearly 55 percent are male.
Opana (oxymorphone) has a half-life of approximately 4 hours. That means dependent users begin to feel withdrawal symptoms around that time. “We have heard that folks are injecting from 4 to over 10 times a day,” one official said.
Once crushed, the Opana pills are less “dissolvable” than, for example, heroin. The anti-abuse formula renders it thick and lumpy, requiring a thicker gauge needle to inject. “That is making the sharing of needles an even higher risk activity,” said Health Commissioner Adams, “because you’re being inoculated with higher amounts of HIV virus.”
Needle exchange programs are currently illegal in Indiana, so the only recourse for addicts is to buy or steal new needles, or share used needles. In late March, Indiana Governor Mike Pence (R) signed an executive order authorizing a 30-day needle exchange program, and then was persuaded to extend the program for another 30 days. But needle exchange alone “is minimally effective,” said Adams, “so it must be part of a comprehensive response.”
Indiana has a prescription drug monitoring program that lets health officials give physicians feedback about their prescribing habits, Adams said. The state also is taking “a four-pronged approach to the outbreak” that includes the development of a ‘one-stop shop’ that provides testing, treatment, and follow-up; a needle-exchange program now being offered by the Scott County Health Department; a public awareness campaign and additional HIV testing and treatment at a local health clinic.
“This outbreak that we’re seeing in Indiana is really the tip of an iceberg of a drug abuse problem that we see in the U.S. that is putting people at very high risk for infectious diseases,” Adams said.
And the CDC has released a health advisory to alert healthcare providers and health departments of the HIV outbreak and HCV co-infection. The advisory details how to identify and prevent the spread of HIV and HCV and urges providers to refer patients with substance abuse problems for medication-assisted treatment and counseling.
The principal adverse effects of Opana (oxymorphone) are similar to other opioids. The most common are constipation, nausea, vomiting, dizziness, dry mouth and drowsiness. Of course, it’s highly addictive and can lead to dependence, withdrawal symptoms or overdose.
Here at Novus, we routinely achieve great success treating dependencies to prescription opioids such as Opana ER. If you or a loved one needs help with an opiate dependence, don’t hesitate to call Novus. We’re always here to help.